Page 101 - Medicare Benefit Policy Manual

• PAs - to the extent authorized under State scope of practice. See qualifications
under chapter 15, section 190 of the Benefit Policy Manual, Pub. 100-02.

• Independently Practicing Psychologists (IPPs)

• PTs, OTs and SLPs - see qualifications under chapter 15, sections 220-230.6 of the
Benefit Policy Manual, Pub. 100-02.

Psychological and neuropsychological tests performed by a psychologist (who is not a
CP) practicing independently of an institution, agency, or physician’s office are covered
when a physician orders such tests. An IPP is any psychologist who is licensed or
certified to practice psychology in the State or jurisdiction where furnishing services or, if
the jurisdiction does not issue licenses, if provided by any practicing psychologist. (It is
CMS’ understanding that all States, the District of Columbia, and Puerto Rico license
psychologists, but that some trust territories do not. Examples of psychologists, other
than CPs, whose psychological and neuropsychological tests are covered under the
diagnostic tests provision include, but are not limited to, educational psychologists and
counseling psychologists.)

The A/B MAC (B) must secure from the appropriate State agency a current listing of
psychologists holding the required credentials to determine whether the tests of a
particular IPP are covered under Part B in States that have statutory licensure or
certification. In States or territories that lack statutory licensing or certification, the A/B
MAC (B) checks individual qualifications before provider numbers are issued. Possible
reference sources are the national directory of membership of the American
Psychological Association, which provides data about the educational background of
individuals and indicates which members are board-certified, the records and directories
of the State or territorial psychological association, and the National Register of Health
Service Providers. If qualification is dependent on a doctoral degree from a currently
accredited program, the A/B MAC (B) verifies the date of accreditation of the school
involved, since such accreditation is not retroactive. If the listed reference sources do not
provide enough information (e.g., the psychologist is not a member of one of these
sources), the A/B MAC (B) contacts the psychologist personally for the required
information. Generally, A/B MACs (B) maintain a continuing list of psychologists
whose qualifications have been verified.

NOTE: When diagnostic psychological tests are performed by a psychologist who is not
practicing independently, but is on the staff of an institution, agency, or clinic, that entity
bills for the psychological tests.

The A/B MAC (B) considers psychologists as practicing independently when:

• They render services on their own responsibility, free of the administrative and
professional control of an employer such as a physician, institution or agency;

• The persons they treat are their own patients; and